The Texas Drug Utilization Review (DUR) Board met on Friday, November 12, 2021, to recommend Medicaid clinical prior authorizations and drugs for the preferred drug list. A summary of this meeting is now available from the Texas Vendor Drug Program (VDP) website.
Clinical Prior Authorization Reminders
The following are reminders for clinical prior authorizations:
- Clinical prior authorizations for traditional Medicaid and Medicaid managed care organizations (MCOs) may differ. The Pharmacy Clinical Prior Authorization Assistance Chart identifies which MCO uses each prior authorization and how those prior authorizations relate to those that VDP uses.
- Each MCO pharmacy website must include a list of its active clinical prior authorizations.
Preferred Drug List Reminders
The following are reminders for the preferred drug list (PDL):
- All PDL recommendations are pending until the Texas Health and Human Services Commission (HHSC) executive commissioner releases the final decision. HHSC will incorporate the approved decisions from the July and November 2021 board meetings into the PDL published in January 2022.
- Prescribing providers must use the Medicaid formulary and PDL.
- MCOs adhere to the Medicaid formulary and PDL. Providers should evaluate a drug’s formulary status before its preferred status.
About the Texas DUR Board
The next DUR board meeting will be held on Friday, January 21, 2022. Board members meet quarterly in Austin to recommend outpatient prescription drugs for the Medicaid program. The schedule for upcoming meetings, instructions on submitting written materials to the board, and directions about publicly testifying in front of the board are available on the VDP website.
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